Morris Panner, Ambra Health Chief Executive Officer

A picture is worth a thousand words, yet many hospitals and health systems still rely on outdated, siloed, and on-premise technology for storing and transferring medical imaging. This outdated technology leads to most electronic health records (EHRs) missing a patient’s diagnostic imaging and only displaying text-based radiology reports. Imagine Facebook or Instagram with just words and no images; it’s a far less comprehensive picture of the individual.

The COVID-19 pandemic has ushered in a new sense of urgency for facilities to break down traditional barriers and allow seamless access to medical imaging data for trauma transfers, everyday telehealth appointments, second opinions, and more. A patient should never face a care delay due to the delayed arrival of medical imaging.

Teamwork between providers and coordination among various points from imaging centers, primary care physicians, and hospital surgical units are absolutely critical. U.S. hospital mergers and acquisitions have been a high rate for the past several years, and today’s patients may find themselves moving through several different locations rather than completing every test at one large hospital. Many physicians feel “trapped” and exhausted by onsite hardware and siloed systems. The administrative time currently spent shuffling around CDs, rekeying information on studies, and maintaining virtual private networks to exchange imaging and associated data is immensely frustrating and cost prohibitive.

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 has shown that the average facility burns about 1,911 CDs per month. With each CD upload taking a few minutes (in a best-case scenario), that could waste hours each day. Administrators and clinicians are frustrated by this enormous waste of time with over 74 percent believing that eliminating CDs could increase job satisfaction.

Image enabling an EHR system takes away the frustration of dealing with CDs and logging into two systems and toggling between them. Instead, both patient records and imaging are all available directly from within the patient jacket. Single sign-on integration seamlessly authenticates users into the EHR for image viewing, with no need for multiple logins. Since imaging and data are integrated together within the patient jacket, patient health information also remains in sync.

Another key benefit of image-enabling the EHR is that it provides enterprise-wide viewing of a study simultaneously. In other words, multiple specialists can access and view an exam at the same time and from different places. For example, at UC San Diego Health, staff can upload studies off CDs within minutes with Ambra Health, and the study becomes available for network-wide viewing immediately. The workflow allows UC San Diego Health to match data from Epic to the CD and overrides the information on the disk. Ambra’s integration with Epic’s affiliated physician portal enables physicians to view imaging directly from the order record. It can also be configured for the physician to be able to view any prior imaging studies for the patient based on a Medical Record Number (MRN).

The current shift towards telehealth services has forced hospitals and health systems to evaluate their processes for sharing patient data. With the increase of remote visits and desire from patients to have access to their records, remote sharing has become a crucial part of medical records management. Patient and referring physician portals enable hospitals and health systems to automatically and easily share studies and reports with patients and referring physicians, making life easier and more efficient for patient and referring physician populations.

Image-enabling the EHR opens the doors to an image-enabled patient portal. The patient experience starts the moment they walk into your office and are greeted by front desk staff. Wasting time searching for an old CD, struggling to upload the images, or letting a patient know that their images are inaccessible for any reason are a less than ideal way to start any visit. Streamline processes by offering patients the ability to upload prior imaging from CDs directly to you ahead of an appointment. 

Or better yet, stay connected through the cloud to local imaging centers that frequently send to your office so that patient imaging appears directly in your EHR system leading to a seamless appointment. After the appointment is over, providing patients with a user friendly and easy-to-access patient portal is a great way to stay in touch and encourage patients to take control of their own health data and, in turn, their health as a whole.

Image-enabling the EHR can have long-term health benefits for patients. The U.S. Food & Drug Administration’s Center for Devices and Radiological Health (CDRH

Unnecessary Radiation Exposure from Medical Imaging

. The CDRH developed several key initiatives that keep in mind that imaging exams must do more good than harm. Among these was a movement to incorporate key quality assurance practices into both hospitals and imaging facilities.

Image enabling the EHR allows physicians easy access to patient imaging – reducing the number of duplicate test orders and the amount of radiation exposure. In addition, a cloud-based suite allows physicians to not only place the current order, but also search archived imaging for all previous medical imaging associated with that patient across their network.

As busy physicians spend their days suiting up in personal protective gear and face a steady stream of patients, the last thing they should need to worry about is logging into multiple systems to access critical information. It’s time for facilities to push towards greater interoperability and unified systems.

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It is time for facilities to push for greater interoperability and unified systems. 

Why Image-Enabling the EHR Benefits Patients and Providers Alike

A small silver lining of this global pandemic may be the realization that we do not always need to take a full day off work to head to the doctor’s office. The concept of telehealth has existed for several years now but was rarely a reality. In fact, I cannot recall a single physician of mine that offered telehealth as an alternative to appointments prior to the COVID-19 pandemic.

Today, many physicians are more than willing to conduct telehealth visits for minor aches and pains, routine check-ins, an initial screening, or even a second opinion. Not only has the increase in telehealth been beneficial for busy patients (who are often managing both work and children at home) but also for physicians who find themselves in far less crowded offices.

, more than 79 percent of specialists surveyed said that their use of telemedicine has increased since the pandemic began. Many also said that they would continue to use virtual services in the future. The increased use of telemedicine was made possible by several key legislation changes. The U.S. Health and Human Services Office for Civil Rights announced that it will, “not impose penalties for non-compliance with the regulatory requirements under the HIPAA Rules against covered healthcare providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency." Additionally, Centers for Medicare and Medicaid Services 

expanded its Medicare telehealth coverage during the COVID-19 pandemic

 for telehealth services during March and April of 2020. 

Remote Reading? 4 Experts Weigh in on the Post-Pandemic Future of Teleradiology

Telehealth has been a long time coming. Physicians have sought creative ways to reduce the number of patients entering and exiting facilities, including imaging centers, for years, testing a number of different methods. For example, r

 followed patients in 2017-2018 and studied whether an electronic consultation between radiologists and referring physicians could lower unnecessary imaging exams. Positive care improvements were seen with the use of this program. Unnecessary imaging went down and in more than 55 percent of cases, imaging that was still recommended altered patient care plans for the better. 

Radiology as a specialty has always been at the 

 with teleradiology work being commonplace for over a decade. Radiologists are often able to work securely from home and offer tele-consults with patients who may have additional questions regarding findings. At New York University Langone, about 25 percent of radiologists read from home. Today, that number has 

However, both patients and physicians should not dismiss the need for in-person care when appropriate. For example, since the outbreak of COVID-19, there has been a 

 leading to poorer prognosis for patients. 

The post-COVID world will need to establish a critical balance between appropriate telehealth usage and in-person visits, imaging exams, and procedures. Could artificial intelligence play a role in determining usage? Advanced symptom-based algorithms may be one such future tool that aid in differentiating between the necessity for telehealth or in-person care. In addition, wearable technology may be another tool that appropriately flags the need for increased intervention.

Our world is forever changed but what is clear is that telemedicine is here to stay, and facilities should build their strategies in anticipation. Organizations should examine their needs as a whole and avoid building a piecemeal approach to their telehealth strategy. Facilities scrambled to put into place whatever program was needed for initial needs. But, for telehealth to succeed in the long term, a truly robust and comprehensive strategy will be needed. If budgetary constraints are an issue for your facility, consider choosing a platform that could scale up at a later time.

Training for the entire team ranging from administrative support to physicians, and even patients, is also a necessity for long-term program success. A comprehensive approach is one that touches on each part of the healthcare trajectory and takes the patient on the best path possible for an ideal outcome.

Changes from COVID-19 have created a healthcare environment where telehealth – an in particular teleradiology – will be a permanent fixture.


Is Telehealth Here to Stay?

Patients have never been more vested in their own health journey. With new coronavirus infections soaring again across much of the country, it makes sense that we are now hyper-vigilant about the state of our own health.

One need not look far for evidence of this shift in behavior. From new consumer-initiated services that bypass the traditional route of getting referred by one’s primary caregiver for additional testing to receiving results on-demand in a patient portal, patients are hopping into the driver’s seat. In a post-pandemic world are we going to see patients expecting more access to their health data on-demand? 

A healthcare system under transition has meant that more than ever the patient is at the center at every stage of their journey -- from physician, to radiology, to follow-up. But, for radiologists, this shift can pose a significant challenge, because their role has traditionally meant contact mostly with other doctors, with limited patient engagement.

However, radiologists are increasingly changing how they work in order to engage with patients more. With the growth of patient and physician portals, and increasingly activated patients, there are more opportunities for contact than ever.

Patient-centered healthcare initiatives have been underway to empower patients to take more responsibility for their healthcare for years, but the reality has rarely met the enthusiasm. In 2015, a 

study in Perspectives in Health Information Management

 found that approximately half of healthcare providers surveyed who offered patient portals reported that less than 5 percent of their patients actually used it. As of 2018, little had changed: 

 found that only 52 percent of patients were offered online access to their records of which 28 percent had actually viewed them. This level of usage is truly abysmal considering how important online and mobile services are to all aspects of our daily lives.

 are nudging institutions to adopt more tech-friendly practices to engage patients directly and share vital health information, but adoption has been slower than in other industries. This could be due to the fact that the healthcare industry has been slower to build healthcare technology at a consumer-grade or the reality that so many silos exist that it’s more burdensome for the patient to take charge than just let the system work as it always has. Interoperability and standardized data criteria for API developers are the key factors for ensuring effective technological innovation.

The pandemic has ushered in a new sense of urgency for patient-centered care. In the first half of 2020 alone, U.S. digital health companies raised a record-setting $5.4 billion in venture funding 

. This demonstrates there’s never been a greater need—or demand—for technology-enabled healthcare.

Many of the previous barriers to tech adoption rapidly dissolved out of necessity as doctors turned to video conferencing for consultations, labs launched more direct-to-consumer offerings, and patients equipped themselves with medical monitoring devices like pulse oximeters in their homes. It will be paramount that the healthcare industry and technologists alike prioritize consumer demand when considering innovation. With all the complexity in the healthcare system and a patient’s own needs, providing more information without context and within siloed applications may be counterproductive.

The next challenge will be ensuring that with all of this information going directly to the patient, they will continue to have sufficient access to a trusted medical partner to provide actionable advice. In the past, radiologists have broadly been “the doctor's doctor”. But, increasingly activated patients, who are looking to participate more in their care, are looking for access to their complete medical records— from test results to imaging results. While most patients want to receive results directly from their referring physicians, many also want to see their radiology reports and images, too.

Ultimately, patients are looking to receive results from more channels and get more data points. Comprehensive electronic health records, easily accessible by the patient, will be essential. 

As the desire to know more about individual medical records grows, easy accessibility for patients will be vital.

Will the Covid-19 Pandemic Accelerate Patient Access to Data?

Should I go to the doctor? This is a recurring question on the minds of those due for routine appointments, screenings, or maybe even a simple check-in. So far, the public has largely heeded warnings to delay routine screenings and move as many consultations as possible to a virtual setting. While these are all valuable behaviors to reduce the spread of COVID-19, there are certain exams that cannot be done virtually, many of which include routine imaging screenings.

Routine screenings for colon, breast, and cervical cancers have dropped between 

 compared to the previous three years, according to medical records software provider, Epic.

Just how important is routine imaging? A few years ago, the 

 by the American Cancer Society noted a 39-percent reduction in breast cancer deaths since the 1980s due to earlier detection and diagnosis. Screening with low-dose spiral computed tomography (LDCT) has also been shown to reduce lung cancer mortality by about 20 percent compared to standard chest X-ray among current or former heavy smokers ages 55-to-74. Researchers have also been studying the possibilities of other imaging exams for screenings of traditionally hard-to-treat cancers, such as pancreatic and ovarian cancers.

Over the last few years, recommendations have already become increasingly confusing with The U.S. Preventive Services Task Force (USPSTF) changing 

, including raising the suggested annual mammography age to 50 for women instead of the previously recommended 40. Their concern was that false positives led to unnecessary and often stressful biopsies for women. However, many physicians and radiologists strongly disagree with these recommendations. Over 

 of physicians still suggest that routine mammography screenings should begin at age 40.

So, if these imaging exams are so valuable, how long exactly can you wait for routine screenings? The information here is highly muddled. Currently, the American Cancer Society 

 that routine screenings should be skipped. They say a delay of one-to-two months is okay for those at average-to-low risk. However, those at high risk due to a family or personal history of cancer should discuss their case with their physician. Some screenings can even be done at home if needed, like colorectal screenings, using an at-home test. Non-imaging related exams like physician, well-woman, and annual skin cancer screening can often be conducted virtually initially and, then, a determination can be made on a date for an in-person visit.

Healthcare technology vendors can help retain imaging value while reducing volume by providing patients with enhanced access to past imaging and allowing them to share data with providers through patient portals, image-enabled EHR portals, and more. The ability for a patient to send and consult with a physician on prior imaging may allow both parties to make a more educated decision on the timing of future exams.

In some cases, certain risk factors might push a physician to encourage someone to stay at home and put off routine exams for longer. Patients should always consult with their own physician on their personal health history and weigh the pros and cons of routine imaging. However, as imaging centers increasingly take new precautions on the safety of their facilities and add new technology that could reduce in-person interaction where possible, healthy patients will likely be able to resume necessary and routine image screening.

With safety precautions in place, imaging centers can consider bringing in healthy patient for screenings.

Author | Morris Panner, Ambra Health Chief Executive Officer

Articles

Why Image-Enabling the EHR Benefits Patients and Providers Alike

Is Telehealth Here to Stay?

Will the Covid-19 Pandemic Accelerate Patient Access to Data?

Assessing Value Versus Risk for Routine Screenings